HoLEP – ThuFLEP Laser Prostate Surgery

What is the Prostate?

The prostate is an organ found in every man, located at the exit of the bladder and surrounding the urethra. Normally weighing 18–20 grams, its function is to contribute to the production of the fluid portion of semen and to produce protective substances against urinary tract infections. The prevalence of benign prostate enlargement increases with age and is observed in 50–80% of men over the age of 50. It can cause complaints such as difficulty urinating, feeling incomplete emptying after urination, waking up at night to urinate, frequent urination, interrupted urination, and urinary incontinence.

 

What is HOLEP – How is it Done?
HOLEP, which stands for Holmium Laser Enucleation of the Prostate, is a surgery performed using laser energy through the urinary tract to treat benign prostatic hyperplasia (BPH). This method is considered the GOLD STANDARD treatment worldwide, especially for larger prostates.

In the HOLEP procedure, the prostate tissue causing difficulty in urination is removed using a laser, by entering the urinary tract without any cuts or surgical scars. Since the tissue penetration depth of the Holmium Laser used in HOLEP is 0.4 mm, it does not harm the nerves related to sexual function. The prostate tissue that is pushed into the bladder is then fragmented into small pieces by a special tool called a "morsellator." The extracted prostate tissue is sent for pathological examination.

What are the Advantages of HOLEP Treatment?

• The procedure is done completely closed through the urinary tract without any incisions made on the body.
• It can be safely performed on prostates of all sizes.

Does Prostate Enlargement Recur After HOLEP?

• Since no prostate tissue remains to grow, recurrence is not observed.

Are There Any Sexual Side Effects After HOLEP?

• Erectile dysfunction does not occur after HOLEP surgery. In fact, for patients whose nighttime urination decreases, penile hardness during the night becomes more persistent, which helps improve erectile quality post-surgery. Semen production and ejaculation decrease after HOLEP.

Is There Urinary Incontinence After HOLEP?

• Since the sphincter muscle, which controls urine retention, is preserved and protected during the procedure, no spontaneous urinary incontinence occurs.

Can Patients Using Blood Thinners Have HOLEP?

• Since bleeding vessels are sealed instantly with the laser during HOLEP, blood loss is minimal. HOLEP can be performed safely in patients using blood thinners, though some may need to stop using these medications a few days before surgery.

Can Elderly Patients or Those with Diabetes, Hypertension, or Heart Disease Have HOLEP?

• Having heart, lung, diabetes, or hypertension issues does not prevent surgery. It is the safest surgical option for elderly patients.

What Type of Anesthesia is Used for HOLEP?

• HOLEP surgery is performed with spinal anesthesia (numbing from the waist down); patients do not need to be fully asleep. Patients may choose to watch their surgery on a screen. If preferred, or if the anesthesiologist deems it appropriate, general anesthesia can be used.

How Long Do Patients Stay in the Hospital After HOLEP?

• The hospital stay is very short, and most patients are discharged within a day.

When Can Patients Return to Normal Life After HOLEP?

• Since recovery is rapid, patients can return to their normal daily activities very quickly. After discharge, patients can engage in eating, drinking, socializing, and working without exerting themselves too much.

When is the Catheter Removed After HOLEP?

• The catheter is typically removed the day after surgery. Patients are discharged without a catheter unless there is a special condition.

Does HOLEP Damage Nerve Tissue?

• Since no electrical energy is used, surrounding tissues and nerves are not harmed, and no electrical burns occur. This ensures that nerves related to sexual function and the urinary sphincter are not damaged.

Is Cancer Investigated During HOLEP Surgery?

• Pathological examination is conducted on the tissue samples taken to check for cancer. If cancer is found, treatment will be adjusted accordingly. HOLEP does not treat cancer.

Who Can Have HOLEP?

• Patients who are unable to urinate and use a catheter.
• Those who continue to have urinary problems despite using prostate medication or who do not benefit from the medication.
• Patients with recurrent urinary tract infections due to prostate enlargement.
• Patients with recurrent urinary tract bleeding.
• Those with kidney enlargement due to prostate growth.
• Patients with bladder stones.
• High-risk patients with serious heart and lung diseases who cannot undergo other surgical methods can also undergo HOLEP surgery.